Communities: "Missing Partner" is Local Ingredient

In this Global Health blog, Ann Starrs discusses the need to address health problems locally while working on policy advocacy and seeking fiscal commitments nationally and internationally. "We know that national laws and health policies have profound impacts on the quality of people's lives, on their ability to exercise and enjoy their human rights, on their safety, security, health, survival. But real success in ending the numerous health catastrophes that challenge developing countries will require us to walk the dusty village roads as well as the marble halls of power." Her argument is that there is a need for more demand, as well as supply, of maternal healthcare.

Starr describes the work of Family Care International (a non-governmental organisation, based in the United States, with a commitment to improving maternal health). "Thinking globally, we and our colleagues argue, cajole and demand that national and international leaders use their power to save women's lives....But...policy alone will not solve the problem....[C]lean, accessible, professionally-staffed health centers can only save the lives of women who use them. Real solutions require a focus not only on supply, but on demand as well. And in many villages, in many countries, social and cultural barriers - traditional health practices, gender inequities, taboos and other beliefs, insensitive medical practices - keep women away from clinics....Communities - and the respected, influential local leaders who can be such powerful agents of change at the grassroots level - need the education and empowerment to take ownership of their local health services, to demand and create accountability (through structures like facility management committees), and to help change the social and cultural norms that stand between women and the skilled care that they need."

"Strategies for engaging communities are strikingly missing from global discussions on effective maternal health interventions, and from national road maps for reducing maternal deaths. When they are mentioned, communities are generally envisioned as targets for behavior change information, but rarely as active partners in effort to improve the availability, quality, and utilization of the health services that can prevent women from dying. Building communities' capacity to overcome barriers to care - persuading women to use, and empowering them to demand, the care that can save their lives - will begin to unlock the demand side of the maternal health equation."

Starr concludes that: "In a world in which all health care is local, communities are the missing partner in efforts to end maternal mortality."